News & Comment

Long COVID, which refers to post-acute and chronic sequelae of SARS-CoV-2 infection, can affect nearly every organ system and all demographic groups. The high and growing toll of long COVID calls for an urgent need to understand how to prevent and treat it. Governments and health systems must address the care needs of people with long COVID.

In the wake of the Supreme Court’s decision to abolish the right of American women to a pregnancy termination, the most vulnerable women, including those with chronic kidney disease, require heightened care and attention. Nephrologists need to urgently evolve expertise in reproductive care to ensure their health and well-being.

Considerable research and investment have focused on the use of electronic patient-reported outcomes (ePROs) in nephrology. However, systematic collection of ePROs to inform the care of patients with chronic kidney disease remains sporadic. A change in culture is needed to encourage their wider adoption in clinical practice.

Kidney disease is an underappreciated medical complication of anorexia nervosa. Further research is needed to clarify the mechanisms that drive kidney disease in patients who restrict caloric intake or engage in purging. Education and awareness are also needed, because kidney disease is often under-recognized by these patients and their clinicians.

Indigenous Māori experience inequitably high rates of kidney failure and lower rates of kidney transplant, pre-emptive procedures and home dialysis when compared to the New Zealand population as a whole. Prevention strategies in primary care, cultural safety training and routine clinical audit for renal practitioners alongside Indigenous people in governance, management and the clinical workforce would greatly improve Māori outcomes.

Salt substitution — the partial replacement of sodium with potassium in table salt — is emerging as a powerful public health strategy to reduce hypertension and related diseases. Here, we explore whether salt substitution is suitable for people with kidney disease by weighing the potential cardiorenal benefits against the risk of hyperkalaemia.

The devastating effects of war are far-reaching and particularly affect people with kidney disease. The Ukrainian conflict has highlighted problems encountered in the provision of support for this vulnerable group. On the basis of these and previous experiences in massive disasters, we propose a sustainable action plan to prepare for similar logistical challenges in future conflicts.

Advancing kidney health justice for all requires the kidney-care community to embrace gender-affirming care across the life course, including inclusion of gender minority individuals in research, thoughtful attention to sexual-orientation and gender-identity data collection, as well as the promotion of policies and practices that protect and provide comprehensive care to all patients.

People with chronic diseases are at high risk of becoming innocent victims of the Russian–Ukrainian war, owing to interruption of their health care. More than 10 million Ukrainian people have left their homes and almost 5 million have left the country. Provision of kidney care for these refugees is an emerging challenge.

People who identify as sexual and/or gender minority individuals face unique and challenging inequities in access to health care. They experience bias, discrimination and underinsurance, which limits their access to high-quality care (including for kidney disease). These inequities must be addressed through the provision of safe and inclusive environments, improved identification of disparities and the creation of a pipeline of equity-focused leaders.

Sexual and/or gender minority health-care workers are subject to the heteronormativity and cisnormativity of society and often face open discrimination. Empowering these individuals to bring their full, authentic selves to work so that they can serve their patients and institutions with the totality of their strengths requires institutes and cisgender or straight allies to support LGBTQ+ communities by creating a culture of inclusivity and enacting progressive policies.

The COVID-19 pandemic has highlighted the vital role of vaccination in preventing life-threatening diseases and improving global health. Understanding and addressing the concerns of vaccine-hesitant individuals, including those with chronic diseases, is key to increasing vaccine acceptance and uptake.

Decades of research have revealed that nephron number is a crucial determinant of kidney health. However, a lack of appropriate tools has limited these studies to ex vivo analyses. For the first time, techniques are emerging that might enable the use of functional nephron number as a biomarker in living humans.

Dominant narratives that describe the power of individual-level resilience underplay the long-lasting consequences of structural violence and perpetuate harms to historically marginalized patients and communities. It is time to update our approaches and narratives by addressing the root causes of inequities through redress and collective resistance to create the equitable conditions needed for communities to thrive.

Increased awareness of chronic kidney disease among the general public is required to facilitate action to improve kidney health. An integrated approach involving mass media campaigns, primary health-care interventions and advocacy is needed to draw attention to chronic kidney disease and shift the focus from kidney failure to achieve a public health perspective on this disease.

Living with chronic kidney disease (CKD) is not easy, and patients must adopt lifestyle changes that can be difficult. Owing to the complexities of the disease, patients must be supported to improve their understanding of CKD and to enable them to make informed decisions about the management of their disease.

Growing patient empowerment and the deluge of health information and misinformation have highlighted the importance of health literacy. Unfortunately, public information and literacy programmes often fail to counter the effect of misinformation. Successfully countering misinformation presents distinctive challenges beyond patient education, and may require trust built on collaborative patient–clinician relationships.